Waist Circumference Distribution of Chinese School-age Children and Adolescents

Background Waist circumference （WC）, a proxy measure of central body fat, is a better predictor than overall body fat for cardiovascular risk factors in both adults and children. WC cutoffs have been established in many countries, but the national WC reference has not been developed in China. Objective To study the distribution of WC in a representative group of Chinese children for establishing Chinese WC cutoff points. Methods Cross-sectional data obtained from 15 mainland provinces and Hong Kong were collected. There were 160 225 children and adolescents aged 7-18 years old in total. The subjects were divided into five regional groups namely costal city, other city, noah rural, south rural, and Hong Kong, for analyzing the distribution of WC. Results A large variation in WC distribution was found among the five groups for both sexes. Coastal city group had the highest P85 WC values consistently from the early school ages to 18-year-old compared with other groups. In contrast, south rural group had P85 values consistently lagged behind not only the city groups but also the north rural group. Hong Kong group had a high P85 WC at early ages, but because of the smaller increments of WC during adolescence, the P85 curve was gradually exceeded by the north rural groups. Catch-up trend was found in the two rural groups since the peak of puberty. These disparities were caused by not only socioeconomic and urban-rural factors but also north-south differences. Because of the regional variation of WC, a ＂gradient＂ prevalence of central obesity was prospected among these groups. Comparisons of WC distributions between the Chinese and the U.S.A or Netherlands demonstrated the necessary of setting up China＇s own WC cutoffs. Sex and age-specific percentiles were obtained and smoothed by using LMS method. Conclusion The data obtained from this study could be used to develop national WC cutoff points for Chinese children and adolescents.

A population-based survey of gastroesophageal reflux disease in a region with high prevalence of esophageal cancer in China

Background: The exact relationship between gastroesophageal reflux disease (GERD) and esophageal squamous cell cancer (ESCC) is far from clarification. The aim of this study was to investigate the epidemiology of GERD in a region with high prevalence of ESCC in China. Methods: A population-based, cross-sectional study was conducted in a high ESCC prevalent area, Anyang, Henan, China. All subjects fulfilled questionnaires and underwent gastroendoscopy with routine esophageal biopsy. The subjects were divided into GERD subtypes (reflux esophagitis [RE] and non-erosive reflux disease [NERD]) and controls. Odds ratios (ORs) and 95% confidence intervals (Cis) were calculated to examine risk factors for RE and NERD. Results: A total of 2844 subjects were finally enrolled. The prevalence of GERD (RE + NERD) was 17.3%. Among them, 271 (9.53%) adults were diagnosed with RE. The prevalence of RE increased with age (7.09% in 45-50 years, 8.00% in 51-60 years, and 9.53% in 61-69 years,x^2 = 62.216, P < 0.001). Sixty-seven (2.36%) subjects were diagnosed with the silent RE. A total of 221 (7.77%) subjects were diagnosed with NERD. Frequent liquid food consumption (OR [95% CI]: 1.502 [1.076-2.095]) was independent risk factor for RE as well as age, male gender, high body mass index (BMI), ever smoking. Age was independent risk factor for NERD. For silent RE, age, male gender, and frequent liquid food consumption were risk factors. Conclusions: In the population with high prevalence of ESCC, a high prevalence of GERD and inverted proportion of RE/NERD were presented. Age was an independent risk factor for GERD. The male gender, high BMI, smoking, and frequent liquid food consumption may be risk factors for RE but not for NERD.

Epidemiological and clinical features of functional dyspepsia in a region with a high incidence of esophageal cancer in China

Background:Functional dyspepsia(FD)has rarely been investigated in areas with a high prevalence of esophageal squamous cell carcinoma(ESCC).This study aims to reveal the epidemiological and clinical features of FD and organic dyspepsia(OD)in such a population.Methods:A middle-aged and elderly population-based study was conducted in a region with a high incidence of ESCC.All participants completed the Gastroesophageal Reflux Disease Questionnaire and Functional Gastrointestinal Disease Rome III Diagnostic Questionnaire,and they underwent gastroscopy.After exclusion of gastroesophageal reflux disease,uninvestigated dyspepsia(UID)was divided into OD and FD for further analyses.Results:A total of 2916 participants were enrolled from July 2013 to March 2014 in China.We detected 166 UID cases with questionnaires,in which 17 patients with OD and 149 with FD were diagnosed via gastroscopy.OD cases presented as reflux esophagitis(RE),ESCC,and duodenal ulcer.Heartburn(52.94%)and reflux(29.41%)were common in OD,but no symptomatic differences were found between FD and OD.Male sex,low education level,and liquid food were the risk factors for OD,while frequent fresh vegetable consumption was a protective factor.FD included 56(37.58%)cases of postprandial distress syndrome(PDS),52(34.89%)of epigastric pain syndrome(EPS),nine(6.04%)of PDS+EPS,and 32(21.48%)of FD+functional esophageal disorders.The Helicobacter pylori infection rate in FD patients was not higher than that in the control group(34.23%vs.42.26%,P=0.240).Frequent spicy food consumption was associated with PDS(odds ratio[OR]:2.088,95%confidence interval[CI]:1.028–4.243),while consumption of deep well water was protective for PDS(OR:0.431,95%CI:0.251–0.741).Conclusions:The prevalence of FD was 5.11%in the studied population.Gastroscopy should be prescribed for dyspepsia patients in case that ESCC and RE would be missed in UID cases diagnosed solely by the Rome III questionnaire.Trial Registration:ClinicalTrials.gov,NCT01688908;https://clinicaltrials.gov/ct2/show/record/NCT01688908.

Family history of esophageal cancer modifies the association of serum lipids and malignant esophageal lesions:a nested case-control study from the"Endoscopic Screening for Esophageal Cancer in China"trial

Background:The association of lipids and cancer has varied greatly among different cancer types,lipid components and study populations.This study is aimed to investigate the association of serum lipids and the risk of malignant lesions in esophageal squamous epithelium.Methods:In the"Endoscopic Screening for Esophageal Cancer in China"(ESECC)trial,serum samples were collected and tested for total cholesterol(TC),triglycerides,low-density lipoprotein cholesterol(LDL-C),and high-density lipoprotein cholesterol at the time of subject enrollment.Cases were defined as malignant esophageal lesions identified by baseline endoscopic examination or by follow-up to May 31,2018.Controls were randomly selected using incidence density sampling in the same cohort.Conditional logistic models were applied to identify the association of serum lipids and the risk of malignant esophageal lesions.Effect modification was evaluated by testing interaction terms of the factor under assessment and these serum lipid indicators.Results:No consistent association between serum lipid levels and esophageal malignant lesions were found in a pooled analysis of 211 cases and 2101 controls.For individuals with a family history of esophageal cancer(EC),high TC,and LDL-C were associated with a significantly increased risk of having malignant lesions(odds ratio[OR]Highvs.Low TC=2.22,95%confidence interval[CI]:1.14-4.35;ORHighvs.Low LDL-C=1.93,95%CI:1.01-3.65).However,a negative association was observed in participants without an EC family history(ORHighvs.Low TC=0.69,95%CI:0.48-0.98,Pinteraction=0.002;ORHighvs.Low LDL-C=0.50,95%CI:0.34-0.76,Pinteraction<0.001).Conclusions:In this study,we found that the association of serum lipids and malignant esophageal lesions might be modified by EC family history.The stratified analysis would be crucial for population-based studies investigating the association of serum lipids and cancer.The mechanism by which a family history of EC modifies this association warrants further investigation.